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Biomedical subjects

M J Raphael

Publications and source records attributed to M J Raphael.

At least 19 recordsLinked to original sources
PubMed1997

Endoluminal repair of large abdominal aortic aneurysms using PTFE: a feasibility study.

PURPOSE: To investigate the feasibility of using predilated thin-wall polytetrafluoroethylene (PTFE) secured by extra-large Palmaz stents for endoluminal repair of abdominal aortic aneurysms (AAA). METHODS: Thirty-two patients (26 males; aged 69 to 83 years) from three centers (two in Europe, one in Australia) were selected for endoluminal stent-grafting using predilated B-mm PTFE graft material fitted with extra-large Palmaz stents at the terminal ends. Aortoaortic tube grafts were implanted in 12 patients, while the remainder received aortomonoiliac endografts and femorofemoral bypass. Follow-up at 5 days and then biannually was by contrast-enhanced computed tomography (CT) or duplex scanning. RESULTS: There were 13 conversions to open surgery; these patients died within 30 days. Nineteen patients were discharged with functioning endografts within 5 days of treatment. Of these, two have had their grafts removed owing to infection in one and distal stent migration in the other. Two endoleaks have been detected in follow-up; one has been sealed by covered stenting. One twisted graft was repaired by Wallstent implantation. Seventeen patients remain well, one with persistent distal endoleak, but none shows an increase in AAA diameter on imaging over the 6- to 26-month (median 13) follow-up. CONCLUSIONS: These results represent the learning curves of three separate centers. Technical failure and complications were more common early in the study. Advantages of the technique include relative low cost and the ability to tailor the stent-graft to the individual aneurysm.

Aged↗
PubMed1995

Assessment of organ radiation doses and associated risk for digital bifemoral arteriography.

An assessment has been made of the absorbed dose associated with femoral arteriography using a digital imaging system. A bilateral femoral arteriogram was performed on 17 patients, using a filmless 1024 matrix digital image acquisition system with a discrete stepping tube-stand and 40 cm image intensifier. A standardized protocol of manual patient/tube-stand positioning under fluoroscopic control and automatic stepping digital acquisition was followed. Skin entry doses were measured with a dose-area product meter for each stage of the procedure, and the total gonad dose was assessed with thermoluminescent dosimeters (TLDs). Published Monte Carlo simulations were supplemented with further calculations to evaluate organ doses from the dose-area products measured. Comparison with the TLD measurements indicated that this technique over-estimated organ doses by about 30%. A mean effective dose of 3.1 +/- 1.8 mSv was calculated for the procedure, with the greatest dose burden being imposed by fluoroscopy during catheter manipulation. The related radiation detriment is 0.018%, which is insignificant when compared with the overall mortality from peripheral vascular disease.

Aged↗
PubMed1990

A new complication of coronary arteriography.

The introduction of a sharply angulated catheter through an arterial sheath for percutaneous coronary arteriography was associated in 7 cases with dissection of the iliac arteries; this extended to the lumbar aorta at the level of the coeliac axis. The catheter tip should be introduced gently and preferably straightened out with a good length of guide wire to avoid this complication.

Angiography↗
PubMed1990

Iliac artery rupture during percutaneous angioplasty.

Percutaneous transluminal angioplasty of the iliac vessels is a generally safe procedure with good results. A rare but potentially fatal complication is iliac artery rupture; we present such a case with its management and review the literature.

Aged↗
PubMed1987

The plain chest X-ray in acquired heart disease in adults.

The chest X-ray is a cheap, easily repeatable and reproducible method of investigating the structure and function of the heart. While it is rarely of decisive diagnostic importance in the setting of modern methods of noninvasive investigation, it is valuable in evaluating the severity of cardiac pathology and also in revealing unsuspected abnormalities which may complicate management. For this reason all patients should have a chest X-ray, preferably both frontal and lateral, at the first attendance for cardiac evaluation. In most cardiac departments a routine frontal chest X-ray is taken at each outpatient appointment.

Adult↗
PubMed1986

Comparison of the ST/heart rate slope with the modified Bruce exercise test in the detection of coronary artery disease.

The rate of depression of the ST segment with increasing heart rate (HR) during exercise has been claimed to predict the extent of coronary artery disease (CAD). To determine whether the maximal ST/HR slope is better than the Bruce treadmill exercise test for predicting the presence of CAD, the maximal ST segment/HR slope was calculated in 81 patients and compared with the results of a standard 12-lead exercise test. In 21 patients (26%), the ST/HR slope could not be calculated. In 60 patients with ST/HR slope values, the extent of CAD was predicted in 24 patients (40%). The sensitivity and specificity of the ST/HR slope in predicting the presence of CAD in the 60 patients with slope values were 91% and 27%, respectively. The sensitivity and specificity of the modified Bruce treadmill exercise test in the 81 patients were 81% and 64%, respectively. Thus, the use of the ST/HR slope does not provide additional information that cannot be obtained using the standard Bruce exercise test.

Adult↗
PubMed1985

Coronary transluminal angioplasty.

Obstructive coronary artery disease is widespread, fatal, and difficult to treat. Up to now, treatment has hinged on medical or surgical treatment. Transluminal angioplasty of the coronary arteries has been introduced as a simple method of relieving coronary artery obstruction with a high initial success rate and a short period of hospitalization.

Angioplasty, Balloon↗
PubMed1984

Inability of the ST segment/heart rate slope to predict accurately the severity of coronary artery disease.

Analysis of the ST segment/heart rate slope during exercise testing has been suggested as a method of accurately predicting the presence and severity of coronary artery disease. Exercise tests were performed in 78 patients presenting with the chest pain to determine the maximum ST segment/heart rate slope. In 21 (27%) patients the ST segment/heart rate slope could not be calculated in any electrocardiographic lead. In the remaining 57 (73%) patients the maximum ST segment/heart rate slope accurately predicted the presence or absence of coronary disease in 44 patients (sensitivity 90%, specificity 40%). In addition, the extent of coronary disease was accurately predicted in 24 patients (sensitivity 42%). Thus the maximum ST segment/heart rate slope did not perfectly predict either the presence or the severity of significant coronary artery disease.

Adult↗
PubMed1982

Emission tomography in embolic lung disease: angiographic correlations.

The data from 84 patients with suspected embolic lung disease who underwent radionuclide section scanning of the chest is reported. All underwent additional conventional planar imaging; specific angiographic evidence of embolic disease was available in 12 cases. A good correlation between the section scans and angiography was obtained. Greater sensitivity in lesion detection was obtained by multiplane section imaging, which should reduce the number of diagnostic uncertainties in embolic lung disease.

Humans↗
PubMed1982

Hemodynamically significant anomalies of the coronary arteries. Surgical aspects.

In 78 (0.9%) of 8,283 patients without associated congenital heart disease studied by angiography, one or more major elements of the coronary arterial system originated in an ectopic manner. Symptoms attributable to the aberrant vessel more present in 20 of the 78 patients and in 15 patients these anomalies were treated surgically. The hemodynamically significant anomalies which lead to abnormalities of myocardial perfusion are of particular surgical importance. There are 4 major types: 1) aberrant origin of the left anterior descending branch from the pulmonary artery; 2) origin of the left coronary artery from the right aortic sinus; 3) origin of the left coronary artery from the pulmonary artery and 4) severe atherosclerotic occlusive disease in an aberrant vessel. The incidence, angiographic features and surgical aspects of these anomalies are discussed.

Adolescent↗
PubMed1981

Is preoperative localisation of insulinomas necessary?

During the past 20 years 33 patients suspected of harbouring an insulinoma have been investigated. 29 had laparotomy, and tumours were removed from 27.2 of the 29 and 1 other proved not to have an insulinoma, although preoperative imaging had suggested a tumour. Four different localisation procedures were used, and in some patients more than one technique was applied. Selective arteriography of branches of the coeliac axis showed the position of the insulinoma correctly in 9 out of 18 cases, but in all of these the tumour was felt at operation, so that the information provided was unnecessary. Arteriography gave false localisation in 4 patients and missed the tumour completely in 4 but was also negative in 1 patient not harbouring a tumour. Ultrasonic examination provided correct localisation in only 2 out of 11 instances and computer-assisted tomography in 1 out of 8. Insulin estimation in blood obtained at percutaneous transhepatic portal-venous sampling (THPVS) provided correct localisation in 2 out of 8 cases, but in only 1 of these was it needed to guide pancreatic resection. Localisation was spurious in 5 patients, and in 1 there was no evidence of a tumour at all. In 23 patients the surgeon felt and removed the insulinoma at the first operation. In 3 tumour was palpable at a second laparotomy some years later. In only 1 was no tumour felt at operation. The false-positive findings in the THPVS were caused by misinterpretation of data. For a peak of insulin concentration in the portal vein to be meaningful, it should exceed 200 mU/l and to be fully diagnostic it should be greater than 500 mU/l. Present imaging techniques are not precise enough to localise an insulinoma. An experienced surgeon has a very high probability of being able to palpate the tumour at operation, and preliminary localisation is therefore not needed in most cases.

Adenoma, Islet Cell↗